{
 "checked": "2026-10-20",
 "changes": [
  {
   "date": "2027-04-01",
   "state": "IN",
   "type": "rate_cut",
   "title": "Scheduled: additional 4% cut to all ABA codes",
   "detail": "Further 4% max-fee cut including group codes (97153 -> $15.39; 97155 U3 -> $24.93).",
   "status": "scheduled",
   "effective": "2027-04-01",
   "source_url": "https://www.in.gov/medicaid/providers/files/bulletins/BT202627.pdf",
   "source_title": "IHCP Bulletin BT202627 (Feb 26, 2026)",
   "verification": "primary",
   "checked": "2026-10-20"
  },
  {
   "date": "2026-10-01",
   "state": "NY",
   "type": "rate_cut",
   "title": "97153 cut 33% to $9.63/unit",
   "detail": "Third cut in a year: technician direct therapy (97153) drops from $14.45 to $9.63 per 15 min ($38.52/hr) for Medicaid fee-for-service, a cumulative ~50% cut from $19.26. Authorized by the FY2026-27 enacted budget. Other ABA codes stay at $19.26.",
   "status": "in_effect",
   "effective": "2026-10-01",
   "source_url": "https://www.health.ny.gov/health_care/medicaid/program/update/2026/docs/mu_no09_aug26_pr.pdf",
   "source_title": "NYS Medicaid Update, Aug 2026 (Vol. 42 No. 9)",
   "verification": "primary",
   "checked": "2026-10-20"
  },
  {
   "date": "2026-10-01",
   "state": "IN",
   "type": "coverage_limit",
   "title": "ABA ends for Medicaid members 21+",
   "detail": "IHCP no longer authorizes or reimburses ABA for members 21 and older for dates of service on/after Oct 1, 2026, after a 6-month transition window (Apr 1 - Sep 30, 2026). ABA is now covered only through EPSDT.",
   "status": "in_effect",
   "effective": "2026-10-01",
   "source_url": "https://www.in.gov/medicaid/providers/files/bulletins/BT202627.pdf",
   "source_title": "IHCP Bulletin BT202627 (Feb 26, 2026)",
   "verification": "primary",
   "checked": "2026-10-20"
  },
  {
   "date": "2026-07-01",
   "state": "VT",
   "type": "billing_rule",
   "title": "ABA moves from tiered case rate to fee-for-service",
   "detail": "DVHA stops reimbursing the tiered monthly case rate; all ABA billed fee-for-service. Expected to be budget neutral. The state said it will not reverse the concurrent-billing ban.",
   "status": "in_effect",
   "effective": "2026-07-01",
   "source_url": "https://humanservices.vermont.gov/sites/ahsnew/files/documents/26-058-F-GCR-ABA-Transition-to-FFS.pdf",
   "source_title": "Vermont GCR 26-058 (final)",
   "verification": "primary",
   "checked": "2026-10-20"
  },
  {
   "date": "2026-07-01",
   "state": "CO",
   "type": "audit",
   "title": "Extrapolated overpayment audits authorized (HB26-1412)",
   "detail": "For audits started after July 1, 2026, HCPF may recover pediatric behavioral therapy overpayments (2022-23 services; 2024-25 if a pattern is found) using statistical sampling and extrapolation.",
   "status": "enacted",
   "effective": "2026-07-01",
   "source_url": "https://www.leg.colorado.gov/bills/HB26-1412",
   "source_title": "Colorado General Assembly: HB26-1412",
   "verification": "primary",
   "checked": "2026-10-20"
  },
  {
   "date": "2026-05-11",
   "state": "GA",
   "type": "mco_cut",
   "title": "CareSource: ABA paid at 80% of fee schedule (partly rescinded July)",
   "detail": "Managed care plan CareSource notified ABA providers (Mar 27) of a 20% cut effective May 11, 2026. In July it rescinded the cut for some providers in shortage areas only; others who refused were dropped from network.",
   "status": "partially_reversed",
   "effective": "2026-05-11",
   "source_url": "https://www.wrdw.com/2026/07/22/ga-medicaid-insurer-reverses-20-therapy-rate-cut-not-all-providers/",
   "source_title": "WRDW News 12, Jul 22, 2026",
   "verification": "news",
   "checked": "2026-10-20"
  },
  {
   "date": "2026-04-30",
   "state": "NC",
   "type": "law",
   "title": "HB 696 signed (Session Law 2026-1)",
   "detail": "Medicaid oversight law signed by the Governor Apr 30, 2026. Trade press reports it includes ABA rules such as in-person assessment requirements, a 50% telehealth supervision cap and a minimum supervision floor; read the ratified text for exact provisions.",
   "status": "enacted",
   "effective": "2026-04-30",
   "source_url": "https://www.ncleg.gov/BillLookUp/2025/H696",
   "source_title": "NC General Assembly: H696 / SL 2026-1",
   "verification": "primary",
   "checked": "2026-10-20"
  },
  {
   "date": "2026-04-01",
   "state": "NY",
   "type": "rate_cut",
   "title": "97153 second 12.5% cut to $14.45/unit",
   "detail": "Second of two 12.5% reductions to 97153.",
   "status": "in_effect",
   "effective": "2026-04-01",
   "source_url": "https://bhbusiness.com/2026/09/23/it-is-a-death-sentence-of-a-rate-cut-ny-medicaid-rolls-out-3rd-aba-rate-cut/",
   "source_title": "Behavioral Health Business, Sep 23, 2026",
   "verification": "news",
   "checked": "2026-10-20"
  },
  {
   "date": "2026-04-01",
   "state": "IN",
   "type": "rate_cut",
   "title": "6% cut to individual ABA codes",
   "detail": "6% max-fee reduction to all non-group ABA codes (97153 $17.06 -> $16.04; 97155 U3 $27.63 -> $25.97).",
   "status": "in_effect",
   "effective": "2026-04-01",
   "source_url": "https://www.in.gov/medicaid/providers/files/bulletins/BT202627.pdf",
   "source_title": "IHCP Bulletin BT202627 (Feb 26, 2026)",
   "verification": "primary",
   "checked": "2026-10-20"
  },
  {
   "date": "2026-04-01",
   "state": "IN",
   "type": "hour_cap",
   "title": "4,000-hour lifetime cap on comprehensive ABA",
   "detail": "Up to 4,000 hours (16,000 units) of comprehensive ABA per lifetime; after that, only targeted ABA. IHCP Portal adds visibility into hours used.",
   "status": "in_effect",
   "effective": "2026-04-01",
   "source_url": "https://www.in.gov/medicaid/providers/files/bulletins/BT202627.pdf",
   "source_title": "IHCP Bulletin BT202627 (Feb 26, 2026)",
   "verification": "primary",
   "checked": "2026-10-20"
  },
  {
   "date": "2026-04-01",
   "state": "IN",
   "type": "billing_rule",
   "title": "Telehealth (modifier 95) barred for 97151/97152/97153/97154/0373T",
   "detail": "These codes can no longer be billed with modifier 95. Prior-authorization requests must include caregiver coaching. 97153 may now also be rendered by BCaBA/BCBA/BCBA-D/HSPP (modifiers U2/U3).",
   "status": "in_effect",
   "effective": "2026-04-01",
   "source_url": "https://www.in.gov/medicaid/providers/files/bulletins/BT202627.pdf",
   "source_title": "IHCP Bulletin BT202627 (Feb 26, 2026)",
   "verification": "primary",
   "checked": "2026-10-20"
  },
  {
   "date": "2026-03-25",
   "state": "CO",
   "type": "proposed_cut",
   "title": "Proposed: cut ABA rate benchmark from 100% to 95% of comparable states",
   "detail": "Legislative staff estimated ~$2.7M general-fund savings by paying 95% of the comparable-state average. Status not yet confirmed.",
   "status": "proposed",
   "effective": "2026-03-25",
   "source_url": "https://colohealthplans.org/colorado-is-proposing-major-changes-to-autism-therapy-and-families-are-worried/",
   "source_title": "Colorado Association of Health Plans (news repost)",
   "verification": "news",
   "checked": "2026-10-20",
   "date_note": "Date is the article's publication date (2026-03-25), not an effective date."
  },
  {
   "date": "2026-02-01",
   "state": "CO",
   "type": "audit",
   "title": "Federal OIG: $77.8M improper ABA payments",
   "detail": "HHS OIG estimated Colorado paid at least $77.8M in improper FFS ABA payments for children (plus $207.4M potentially improper), citing documentation, credentialing and referral gaps.",
   "status": "published",
   "effective": "2026-02-01",
   "source_url": "https://oig.hhs.gov/documents/audit/11493/A-09-24-02004.pdf",
   "source_title": "HHS OIG report A-09-24-02004 (Feb 2026)",
   "verification": "primary",
   "checked": "2026-10-20"
  },
  {
   "date": "2026-01-07",
   "state": "NY",
   "type": "pending_bill",
   "title": "A03896: 680-hour annual cap on ABA insurance coverage",
   "detail": "Would cap insurance coverage for ABA (and DIR/Floortime) at 680 hours per person per year (~13 hrs/week). Bill trackers show it referred to the Assembly Insurance Committee on Jan 7, 2026 with no later action; the official page timed out on our check date, so status is not yet re-confirmed.",
   "status": "pending",
   "effective": "2026-01-07",
   "source_url": "https://www.nysenate.gov/legislation/bills/2025/A3896",
   "source_title": "NY Senate: Assembly Bill A3896 (2025-26)",
   "verification": "news",
   "checked": "2026-10-20"
  },
  {
   "date": "2026-01-01",
   "state": "VT",
   "type": "billing_rule",
   "title": "Concurrent billing of 97153 + 97155 banned",
   "detail": "97153 and 97155 can no longer be billed for the same member at the same time (same day at different times is allowed). Telehealth limited to 97155/97156/97157. Estimated savings $1,433,813/yr.",
   "status": "in_effect",
   "effective": "2026-01-01",
   "source_url": "https://humanservices.vermont.gov/sites/ahsnew/files/documents/25-042-F-GCR-ABA-Changes.pdf",
   "source_title": "Vermont GCR 25-042 (final)",
   "verification": "primary",
   "checked": "2026-10-20"
  },
  {
   "date": "2026-01-01",
   "state": "WA",
   "type": "rate_cut",
   "title": "2% cut to ABA fee schedule",
   "detail": "HCA cut FFS rates 2% for 97151, 97153-97157, 0362T, 0373T and H2020, rolling back part of the 2024 increase. Ongoing unless the legislature acts.",
   "status": "in_effect",
   "effective": "2026-01-01",
   "source_url": "https://www.hca.wa.gov/assets/program/managed-care-rate-reductions-guidance-faq.pdf",
   "source_title": "WA HCA: Managed care rate reductions guidance & FAQ",
   "verification": "primary",
   "checked": "2026-10-20"
  },
  {
   "date": "2025-12-10",
   "state": "NC",
   "type": "rate_restored",
   "title": "10% ABA cut reversed",
   "detail": "After court rulings, NCDHHS reversed the Oct 1, 2025 rate reductions and restored Sept 30, 2025 rates; updated fee schedules targeted for Jan 5, 2026, with claims reprocessed.",
   "status": "in_effect",
   "effective": "2025-12-10",
   "source_url": "https://medicaid.ncdhhs.gov/blog/2025/12/19/medicaid-rate-reduction-reversal-update",
   "source_title": "NC Medicaid: Rate Reduction Reversal Update (Dec 19, 2025)",
   "verification": "primary",
   "checked": "2026-10-20"
  },
  {
   "date": "2025-12-01",
   "state": "ID",
   "type": "billing_rule",
   "title": "ABA codes replaced by Behavioral Intervention H-codes",
   "detail": "Behavioral Modification & Consultation (97xxx codes, Magellan) moved to Behavioral Intervention billed to Idaho Medicaid FFS (Gainwell) with Telligen authorizations: e.g. 97153 -> H0004 TG/TF, 97154 -> H0005, 97151 -> H0032.",
   "status": "in_effect",
   "effective": "2025-12-01",
   "source_url": "https://healthandwelfare.idaho.gov/providers/home-and-community-based-services-children-developmental-disabilities/childrens",
   "source_title": "Idaho DHW: Children's DDA providers page",
   "verification": "primary",
   "checked": "2026-10-20"
  },
  {
   "date": "2025-10-01",
   "state": "NY",
   "type": "rate_cut",
   "title": "97153 first 12.5% cut",
   "detail": "First of two 12.5% reductions to 97153 (from $19.26).",
   "status": "in_effect",
   "effective": "2025-10-01",
   "source_url": "https://bhbusiness.com/2026/09/23/it-is-a-death-sentence-of-a-rate-cut-ny-medicaid-rolls-out-3rd-aba-rate-cut/",
   "source_title": "Behavioral Health Business, Sep 23, 2026",
   "verification": "news",
   "checked": "2026-10-20"
  },
  {
   "date": "2025-10-01",
   "state": "NC",
   "type": "rate_cut",
   "title": "10% cut to RB-BHT/ABA codes (later reversed)",
   "detail": "State budget rate reductions cut RB-BHT codes 97151-97157 by 10%.",
   "status": "reversed",
   "effective": "2025-10-01",
   "source_url": "https://medicaid.ncdhhs.gov/spa-25-0026-1-day-public-notice-nc-medicaid-state-budget-rate-reductions/open",
   "source_title": "NC Medicaid SPA #25-0026 public notice",
   "verification": "primary",
   "checked": "2026-10-20"
  },
  {
   "date": "2025-08-01",
   "state": "NE",
   "type": "rate_cut",
   "title": "ABA rates cut after 'market study'",
   "detail": "Nebraska reset ABA rates (97153 to $18.70, 97155 to $22.72, 97154 to $7.49, 97158 to $12.05). Managed care rates adjusted to match. DHHS cites ABA spending rising from $4.6M (2020) to over $85M (2024).",
   "status": "in_effect",
   "effective": "2025-08-01",
   "source_url": "https://dhhs.ne.gov/Medicaid%20Provider%20Bulletins/Provider%20Bulletin%2025-14.pdf",
   "source_title": "Nebraska Medicaid Provider Bulletin 25-14",
   "verification": "primary",
   "checked": "2026-10-20"
  },
  {
   "date": "2025-02-07",
   "state": "NE",
   "type": "hour_cap",
   "title": "Service definitions: up to 30 hrs/week, 6 hrs/day",
   "detail": "Final ABA service definitions allow up to 30 hours/week and 6 direct hours/day unless more is shown medically necessary; RBT supervision raised to 10-20%; 2-4 hrs/month caregiver involvement; treatment plan review every 90 days.",
   "status": "in_effect",
   "effective": "2025-02-07",
   "source_url": "https://dhhs.ne.gov/Medicaid%20Provider%20Bulletins/Provider%20Bulletin%2025-02.pdf",
   "source_title": "Nebraska Medicaid Provider Bulletin 25-02",
   "verification": "primary",
   "checked": "2026-10-20"
  }
 ]
}